Caudal epidural block

If you have a private operation planned, it may involve an anaesthetic procedure, in this instance a caudal epidural block. You may wish to know what this involves.

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

You need an operation in your pelvic region. A caudal epidural block can provide pain relief for any operations involving this region.

What is a caudal epidural block?

A caudal epidural block, often simply known as a ‘caudal’, is an injection of local anaesthetic into the base of your spine. This numbs the nerves that go to your pelvic region.

The pelvic region is at the lower part of your abdomen. It contains your bladder, lower bowel and sexual organs. The nerves that supply sensation to these parts of your body come from the lower part of your spine.

We use this block for pain relief when doing pelvic operations, such as operations on the penis, vagina or anus. A caudal is one of many types of nerve block. This particular nerve block is always used with a general anaesthetic. You will be unconscious when the block is done and for the rest of the operation.

The aims

The aim is to numb the nerves in your pelvic region, so that you feel no pain from the operation. This will work during the operation and for several hours afterwards.

The benefits

The caudal block usually lasts for several hours. Your bottom and the area around your genitals will be numb when your operation is over. This keeps you comfortable when you wake up. Having this block will reduce the amount of other painkillers you need during and after the operation. This is often the main reason for using this block. This gives a faster recovery and less sickness after the operation.

There are other benefits. If you have a medical condition, such as heart disease, it is important to have good pain relief. Pain causes stress and may raise your blood pressure. This could put unnecessary strain on your heart. Having your operation with a caudal and a general anaesthetic will cause less stress to your heart. It will be safer.

Are there any alternatives?

There are several alternatives to a caudal.

General anaesthetic: You can have a general anaesthetic, where you are unconscious for the operation, but without the caudal. Other strong painkillers, such as morphine, can be given to keep you comfortable when you wake up.

Epidural: With an epidural anaesthetic we place a needle into the space close to your spinal canal. We thread a plastic tube down the needle. We give drugs through the tube. This will numb you for the operation. We can give more drugs through the tube to provide pain relief for several days after the operation. The tube lies just outside the covering of your spinal cord, which is called the dura, hence the name epidural.

Spinal: It may be suitable to give a single injection, like an epidural, but without putting the plastic tube in. This single injection is called a ‘spinal’. It does not last as long as an epidural. It cannot be left in for pain relief after the operation.

Local anaesthetic: Sometimes, if the surgery is minor, we can give local anaesthetic injections to numb the operation area only.

If you are to have one of these procedures there is another information leaflet that will tell you more about it.

Who should have it done?

Patients needing surgery on any part of the pelvic region could require a caudal epidural block.

Who should not have it done?

If you are unhappy about the procedure for any reason, you should not continue. It is not essential to have a caudal. There are specific medical situations when a caudal block should not be done and they are as follows:

If you are taking medicines that prevent your blood from clotting, such as Warfarin. This would lead to more bleeding than normal. Bleeding around the nerves in the spine is a serious problem and must be avoided.

If you have an illness that prevents your blood from clotting, such as haemophilia. This would also lead to bleeding around the nerves in the spine.

If you have unusual or difficult spine anatomy. This would make it difficult to put the needle in the correct place.